It’s Time to Help Africa Fight the Virus
The continent is ripe for a public health disaster, and Western powers must step in to prevent another global catastrophe.
The next time you react when your six-foot perimeter is violated at a grocery store or on the sidewalk, imagine how much worse it could be. For hundreds of millions of people who live in unplanned settlements, slums, and refugee camps around the world, anything approaching social distancing is a cruel impossibility.
Likewise, the next time you wash your hands, think of the 3 billion or so people who cannot do so within the safety of their own homes due to lack of running water.
If you wonder whether to call your doctor about a cough or fever, recall that Africa has less than one-tenth the number of doctors per capita as the United States and an even greater shortage of essential medical technology. (Sierra Leone has only a handful of ventilators for nearly 8 million people.)
Johns Hopkins University’s global map tracking the coronavirus shows that it has barely reached sub-Saharan Africa yet, compared to most of the Northern Hemisphere. There are only 33,748 reported cases as of April 27, about 1 percent of all cases reported globally.
[Mapping the Coronavirus Outbreak: Get daily updates on the pandemic.]
But any serious global strategy to deal with this pandemic must look at the horizon, where a brewing African catastrophe is taking shape.
If COVID-19 spreads across Africa, it would not only be a human catastrophe for the continent, but one that threatens the Northern Hemisphere with future outbreaks and further human and economic losses. What is true in the United States, where people in poor and minority neighborhoods are dying in disproportionate numbers, is true for the world as a whole: No one will be safe so long as anyone is at risk.
If the United States, Europe, and others succeed in containing the virus in the coming months, there is no way contagion throughout Africa could be contained there. A second wave rising in Africa would almost surely crash on U.S. shores. In this way, the coronavirus pandemic has laid bare the world’s interdependence; the future safety of every U.S. community therefore depends on the success of every community in Africa and elsewhere.
While giving priority to the fight here at home is essential, the time to help Africa fight the virus is now.
It’s true that Africa’s population is younger than most, with a median age of only 19.7 years, and potentially less vulnerable. It’s also true that African urban areas are generally farther apart and Africans travel from area to area less frequently than in many of the world’s most industrialized countries. And some countries, such as Nigeria, Liberia, Uganda, and others that have dealt with Ebola, have built on their hard-won achievements and put into place structures from dealing with previous contagions.
But throughout the continent there are crowded slums; challenged health systems; scarce medical resources; immune systems weakened by malnutrition, HIV, malaria, tuberculosis, and other diseases; and growing but vulnerable economies. These factors make the outlook grim.
That is why the World Health Organization (WHO) and leading advocates are calling for immediate attention to Africa.
As Americans have learned to their growing sorrow, a delayed start in responding fully to the pandemic means far more unnecessary deaths and greater economic loss than is necessary.
African leaders on the other hand have generally taken swift initial public health actions to combat COVID-19.
South Africa, for example, imposed a nationwide state of disaster on March 15, at a time when there were only 61 reported cases and no deaths. This bought time for training, preparing, and protecting more health care workers; scaling up testing facilities; opening pop-up clinics and employing contact tracing and isolation in high density areas. South Africa’s curve has flattened for now, and the country has far fewer cases (4,793) than initially predicted.
Some nations with strong community health programs and outreach workers, such as Rwanda and Ethiopia, are providing information and support through trusted community leaders to help deploy vast networks of contact tracing and community response. Their leadership in investing in community health worker programs provides a lesson for the United States, United Kingdom, and other high-income nations that are only now scrambling to develop a workforce capable of widespread contact tracing and community support before reopening the economy.
The government of Malawi is using predictive models previously developed for identifying hot spots for food insecurity and malaria risk to target assistance on areas likely to be hit the hardest by COVID-19 (due to age, co-morbidities, population movements, and flu-like illnesses).
In such countries, fast-moving efforts may help them stay ahead of the virus long enough to put into place high-volume testing, contact tracing, and isolation, as well as temporary intensive care facilities with respiratory support. But because so many are living on the edge of poverty, lockdowns are becoming extremely challenging to maintain—as farmers are unable to transport their food, markets are closed, and those reliant on daily income from the informal labor market lose their means of sustenance, people run out of critical medicines, and pregnant women struggle to find timely transport before giving birth. And the absence in many areas of indoor running water and toilets makes it difficult or impossible to obey “wash your hands” public service announcements.
For many African countries, a delayed but still exponential growth of COVID-19 cases seems very likely. The Africa Centres for Disease Control and Prevention (Africa CDC) has called COVID-19 an “existential threat,” and reported a 43 percent increase in new cases over one week in April. The WHO is warning that the continent could see 10 million cases. Despite their best efforts to prepare, health systems could quickly be overrun by a lack of health care workers, an inability to maintain lockdown, and a supply of personal protective equipment, test kits, and ventilators choked off by global competition.
This deadly mix must be addressed and ameliorated through massive, urgent global support. Unlike the 2014-2016 Ebola outbreak, which focused on three countries in West Africa, COVID-19 infections have been confirmed in 52 African nations to date, including multiple countries with ongoing conflicts and substantial populations of internally displaced persons.
The U.S. government and other wealthy nations have an opportunity to play a positive—even transformational—role by supporting African governments and other actors. In coordination with United Nations agencies, the World Bank, the Africa CDC and the African Union, the African Development Bank and others, Washington can help vulnerable nations battle the virus and reduce future waves of infection on its own shores.
Congress should bolster the U.S. response to the global epidemic—an extension of the domestic response—through urgent, supplemental funding. Meeting needs such as prefabricated intensive-care units, bolstering food security and availability of water, sanitation, and hygiene, and supportive care through telemedicine will immediately save lives. In addition, financing is needed for the expansion of other essential elements of health security, such as laboratory strengthening, surveillance support, and personal protective equipment, which is in such short supply globally that the U.S. government has actually resorted to attempting to source supplies from countries that are recipients of U.S. aid.
Congress should also immediately increase support to U.S. global health programs already on the ground. Over the past 17 years, the U.S. President’s Emergency Plan For AIDS Relief (PEPFAR) has spent $75 billion in the African region. Together with the Global Fund to Fight AIDS, Tuberculosis and Malaria, it has changed the trajectory of previously existing pandemics. The incidence of new HIV infections has declined 28 percent in the hard-hit regions of East and Southern Africa since 2010, with deaths declining by 44 percent there over the same period as millions of Africans gained access to antiretroviral therapy in Africa.
These successful health platforms offer the COVID-19 response established networks of data-driven public health leaders, extensive supply chain networks, nimble nongovernmental organizations and front-line health care workers who are already pivoting to support all elements of the coronavirus response on the continent. They are already gearing up their pooled procurement mechanisms to address inequitable distribution of critical supplies. And their involvement, as well as other U.S.-sponsored programs in maternal and child health and family planning, are essential to protecting the substantial gains in HIV, tuberculosis, malaria eradication, vaccination and family planning coverage during the pandemic.
The U.S. government should also provide further support for research and development of medicines and vaccines that can save lives in the United States and beyond. Investments in international partnerships such as the Coalition for Epidemic Preparedness Innovations will help to meet global access needs while leveraging funding from other nations. Additional support for organizations such as Gavi, the Vaccine Alliance can help to ensure advance-purchase commitments are in place to help shape a healthy marketplace that ensures the ability to rapidly scale up production and distribution.
The WHO—despite U.S. President Donald Trump’s threat to withdraw U.S. funding—must continue to play an essential role in supporting coordinated and evidence-based public health action across African and other nations, and Congress should strongly protect its funding.
Bill and Melinda Gates have shown that private citizens can also have a transformational impact on Africa’s health infrastructure, and on April 16 they announced that they will more than double their foundation’s contribution to the WHO. Jack Dorsey, the chief executive of Twitter and Square, pledged to donate $1 billion to relief programs related to the virus. And wealthy celebrities, such as Charlize Theron, Rihanna and Jay-Z have contributed to fight the impact of COVID-19 in Africa.
The economic costs of shortchanging the continent would be high. At the end of 2019, the five fastest-growing economies globally were in Africa; now, sub-Saharan Africa’s gross domestic product is expected to contract by 1.6 percent this year, plunging the region into its first recession in 25 years, according to the International Monetary Fund. South Africa’s economy has already slid into recession and Nigeria and Angola are expected to follow suit. Tourism—a sector that accounts for $40 billion in revenue annually—could collapse. As many as 20 million jobs could be lost in the region, according to the African Union, and foreign investment could decline by 15 percent.
Africa’s cities, where nearly half of the continent’s population lives and where 50 percent of Sub-Saharan Africa’s GDP is generated, could be devastated. The social costs of increasing poverty in Africa will be felt for years as children lose access to schooling and will live with the consequences of early childhood deprivation.
It is understandable that at such a challenging moment, some Americans may want their government to stay focused solely on the COVID-19 crisis at home. This approach is understandable but shortsighted. Even those traditionally skeptical of U.S. engagement abroad must recognize the cascading costs for Americans of new contagions elsewhere. The costs for the United States and the rest of the world will be significant in new waves of migration, lost investments and crippled trading partners, lack of natural resources, interrupted supply chains, and pressure for still greater economic support in the future. Already, African finance ministers are requesting $100 billion for debt relief and economic stimulus.
Most importantly, human lives, in Africa and beyond, are at stake. The virus is attacking all of humanity. Humanity’s response will not only be a test of our sense of collective self-interest, but also of our collective soul.
Charles Holmes is a professor of medicine at Georgetown University and a former deputy U.S. global AIDS coordinator.
Anthony Lake is a former U.S. national security advisor and executive director of UNICEF.
Witney Schneidman is a former U.S. deputy assistant secretary of state for African affairs and senior advisor for Africa at Covington & Burling LLP.